Supervisor Midterm Evaluation

Intern's First Name:		Intern's Last Name:
Supervisor's First Name:		Supervisor's Last Name:
Placement Site:		Supervisor Email Address:
Semester:

Section I: Student Learning

Scale:	0	No Knowledge	3	Acceptable
	1	Poor	4	Above Expectations
	2	Below Expectations	5	Excellent

A:	Ability To Learn
	1: Accepts Constructive Criticism	0 1 2 3 4 5
	2: Utilizes available resources	0 1 2 3 4 5
	3: Asks pertinent and relevant questions	0 1 2 3 4 5
	4: Learns quickly and effectively	0 1 2 3 4 5

B:	Judgment
	1: Considers all factors and circumstances	0 1 2 3 4 5
	2: Demonstrates ability to set appropriate priorities and goals	0 1 2 3 4 5
	3: Works within appropriate authority	0 1 2 3 4 5
	4: Accepts responsibility for all work performed	0 1 2 3 4 5

C:	Relations with others
	1: Supports and contributes to a team atmosphere	0 1 2 3 4 5
	2: Respects the diversity of co-workers	0 1 2 3 4 5
	3: Seeks to support organizational goals	0 1 2 3 4 5
	4: Carries appropriate share of workload	0 1 2 3 4 5

D:	Attitude
	1: Exhibits positive and constructive attitude	0 1 2 3 4 5
	2: Brings a sense of value and integrity to the job	0 1 2 3 4 5
	3: Behaves in an ethical and cooperative manner	0 1 2 3 4 5

E:	Dependability
	1: Meets deadlines	0 1 2 3 4 5
	2: Reports to work as scheduled and on-time	0 1 2 3 4 5
	3: Dress and appearance are appropriate for work environment	0 1 2 3 4 5

F:	Quality of Work
	1: Communicates ideas and concepts clearly	0 1 2 3 4 5
	2: Effectively participates in meeting and group settings	0 1 2 3 4 5
	3: Is self-motivated	0 1 2 3 4 5

If you have any comments about this section, please place them here.

Section II: Attendance and Performance

Attendance:

Regular
Irregular

If irregular, please give a reason here.

Punctuality:

Regular
Irregular

If irregular, please give a reason here.

If you have any comments about this section, please place them here.

Section III: Learning Contract and Supervision

1: Do you have a copy of the student intern's Learning Contract?
Yes No

2: Is the student accomplishing his/her objectives as stated in the Learning Contract?
Yes No

3: Is the student meeting the obligations as contracted?
Yes No

If no, please explain your answer.

4: Has your office been able to provide sufficient tasks and opportunities that enhance the intern's skills?
Yes No

Please explain your answer.

5: Student's Anticipated End Date:

6: How many hours per week does the student spend at the office?
Hours per week

7: How often do you meet with the intern?
Times per week

8: What are the intern's strongest assets?

9: Do you see the need to make any adjustments to the internship at this time?
Yes No

If yes, please explain your answer.

10: Do you wish to meet/discuss with the OIEE staff at this time?
Yes No

If yes, please explain your answer.

If you have any comments about this section, please place them here.

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Contact Information

Office of Experiential Learning and Community Engagement-Internship Programs

Email: intern@etal.uri.edu
Phone: 401-874-2160
Fax: 401-874-4320

We are located in Roosevelt Hall in the South Side Lobby